If you need to add or remove some items or text in an existing PDF, you can use PDF24 to extract (file / save as ...) each page to JPG (or other graphics), edit (e.g. in MSPaint), save and reimport in PDF24 (multi-select). The only thing ist, that the quality of course is not 100% the same and the PDF ist not scannable any more. There's a way to import graphics for free and rejoin to scannable PDF on this page, but it will contain a small watermark at the bottom.
Extract:
Import:
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